Evaluation of Safety and Security Programs to Reduce Violence in Health Care Settings

摘要

Health care workers, especially those providing emergency and psychiatric care, have long been recognized as having a high risk of work-related assault. Nurses are at particularly high risk and they experience the highest reported rates of violence victimization among occupations in the healthcare industry. Although hospital violence is a growing concern, little is known about existing programs or methods to influence hospitals to establish violence prevention and response systems. This study compared workplace violence programs in the high-risk hospital areas of the Emergency Department, the Psychiatric Department, and independent Psychiatric Facilities. Methods. Participating hospitals were identified through a census of licensed acute care hospitals in California and New Jersey. Acute care hospitals were divided into the categories of Level I and II Trauma Centers, Level III and IV Trauma Centers, Acute Care Hospitals without a designated trauma status, and Psychiatric Facilities. Acute care hospitals without a trauma designation were categorized into those with 300 beds or more and those with fewer than 300 beds. In New Jersey, hospitals were randomly selected within each of these categories to represent the statewide distribution. The size of California made it difficult to collect a random sample from the entire state. The sample was selected from 25 of the 58 counties, representing both urban and rural areas of the state. These counties covered approximately 68% of the California population and 65% of the state's hospitals. In California, 144 hospitals were invited to participate and 134 agreed, for a participation rate of 93%. In New Jersey, 81 hospitals were invited to participate, and 54 agreed, for a response rate of 66.7%. Information was collected through interviews, a facility walk-through, and review of written policies, procedures, and training material. Programs were scored on the components of training, policies and procedures, security, and environmental approaches. Results. We found that almost every hospital had taken some steps to reduce violence. Although many hospitals had comprehensive violence prevention programs, many of the programs were severely deficient. When comparing programs in Emergency Departments, California had significantly higher scores for training and policies/procedures, but there was no difference for security and environmental approaches. When comparing Psychiatric Units and Facilities, California had significantly higher scores for policies/procedures, environmental control, and security, but no difference was found for training. In both units, program components were not highly correlated. For example, hospitals with a strong training program were not more likely to have strong policies and procedures. Conclusions. Most hospitals in California and New Jersey had implemented a workplace violence prevention program, but important gaps were found.